Lung transplant patients successfully leave the artificial lung in 37 hours

The world's first lung transplant for patients with new coronary pneumonia. At present, the patient is fully awake and the lungs will be sent to the laboratory for basic research.

On February 29, a team of Professor Chen Jingyu, a lung transplant expert from China and vice president of Wuxi People's Hospital affiliated to Nanjing Medical University, successfully completed the world's first double lung transplantation for patients with negative coronary artery pneumonia in Wuxi. A 59-year-old man was diagnosed as critically ill with COVID-19. After tracheal intubation ventilator application + ECMO maintenance and medication, continuous nucleic acid testing was negative, but his lungs were severely damaged and irreversible. On March 2, a reporter from the Beijing Youth Daily learned that the patient had successfully separated from ECMO (commonly known as "artificial lung") 37 hours after surgery. It is a medical emergency technology device mainly used to provide continuous in vitro for patients with severe heart and lung failure. Breathe and circulate to support the patient's life).

High-speed rail station opens green channel for lung source transfer

In order to ensure the rapid delivery of lung sources to the hospital, Wuxi East Station opened a green channel for organ transfer medical staff. At 17:00 on February 29th, Wuxi East Station Station Manager Zhou Wujie received an urgent call for help from Chen Jingyu. A lung source from Henan Province for organ transplantation for patients with new coronary pneumonia is being escorted to Wuxi East Station by high-speed rail. Quickly transfer to the hospital through the station's green channel. Chen Jingyu emphasized that this time the first lung transplantation for patients with new coronary pneumonia was the world's first.

For organ transplantation, time is life, and lung transplantation for patients with new coronary pneumonia is even more special, but at present, various prevention and control measures need to be strictly implemented. Mr. Zhou opened the green channel for the station as soon as possible, arranged the staff to guide along the way, and actively coordinated and contacted the local health and epidemic prevention and public security departments to form a special team for epidemic prevention and control to stand on the platform in advance.

At 18:20, the G1821 train stopped on time at Wuxi East Station and was led by the station staff. Local health and epidemic prevention personnel and public security personnel respectively conducted "temperature measurement while walking" and "check the travel trajectory while walking" During the implementation of the epidemic prevention and control measures, the outbound time was minimized, so that the outbound process that originally took about 30 minutes was completed in 3 minutes. In the end, the transplanted organ was successfully transported to the local vehicle and sent to the hospital through the green channel.

Successful detachment from artificial lung 37 hours after operation

That night, the operation was performed in the negative pressure operating room of Wuxi Fifth People's Hospital. Chen Jingyu said that this was a psychological and physical test. The team wore three or four layers of isolation protective devices and three layers of gloves, which took more than 6 hours to successfully complete the double lung transplantation operation. The patient returned to the ward at 23:35. After the operation, the patient was awake, his lungs were well oxygenated, and his vital signs were stable. The next step is to carry out follow-up treatments such as anti-rejection and anti-infection after transplantation.

Chen Jingyu said that the patient's removed lung was sent to the P3 laboratory of the Jiangsu Provincial Center for Disease Control and Prevention for anatomy and basic research. Because the diseased lung is directly removed from the patient, this specimen is more valuable than the autopsy specimen.

The reporter from Beiqing Daily got the latest news. After the operation, after comprehensive treatment to prevent transplanted lung reperfusion injury, the patient has successfully separated from ECMO 37 hours after surgery. Examination shows that the transplanted lungs have good oxygenation function and stable vital signs.

dialogue

Patients have a long way to go

Beiqing Daily: How is the patient now?

Chen Jingyu: The patient has successfully separated from ECMO 37 hours after surgery and enjoys free breathing. At present the patient is fully awake, and our team will do rehabilitation exercises for them later. Because of the long-term respiratory support, the patient's overall muscle strength is very poor, and the respiratory muscle strength is also very weak. The road to recovery is still long.

Beiqing Daily: What is the consideration for lung transplantation for this patient?

Chen Jingyu: New coronary pneumonia cases must have three medical prerequisites for lung transplantation: one is that the patient is maintained on a ventilator + ECMO, and bilateral lung failure is irreversible; the second is that the nucleic acid test is negative for many consecutive times; the third is that the other organs are basically normal The general condition can withstand lung transplantation. In this patient, after tracheal intubation ventilator application + ECMO maintenance and drug treatment, continuous nucleic acid testing was negative, but both lungs had severe lesions and were irreversible. On February 24, after discussion by provincial experts, there were indications for lung transplant surgery. On February 28, the patient sustained bleeding in the lungs due to the disease on the right side, and the bleeding volume was estimated to be 2500ml. Hemorrhagic shock was dying. Fortunately, on the 29th, patients with brain death from other provinces donated their lungs with love.

Beiqing Daily: How did this patient get to the lung source?

Chen Jingyu: Except that organ donation and transplantation in Wuhan may have stopped, organ donation and transplantation nationwide is still underway. Lung sources are distributed through the National Organ Distribution System. Patients with ECMO are ranked higher and can be prioritized to the lung source. In fact, six to seven thousand organ donations are completed each year in the country. Only 5% to 6% of the lungs are used each year, and the rest are wasted.

Beiqing Daily: Is the cost of lung transplantation expensive? Can ordinary people afford it?

Chen Jingyu: The cost of lung transplantation in Jiangsu Province is covered by medical insurance. This new pneumonia treatment guideline does not include lung transplantation but ECMO. In fact, the cost of ECMO treatment is also very expensive. Patients have been maintained with ECMO and the cost will be higher than a kidney transplant. Like long-term hemodialysis and kidney transplantation, the cost of kidney transplantation is lower than the cost of long-term hemodialysis. Kidney transplantation has a higher social value and a higher quality of life for patients. The same is true of lung transplantation and ECMO.

Beiqing Daily: What is the significance of this successful surgery?

Chen Jingyu: The success of this operation will provide experience for the treatment of patients with new coronary pneumonia, especially how to select recipients for lung transplantation, improve the cure rate of new coronary pneumonia, and achieve long-term rehabilitation. Our team will summarize the experience in the postoperative management in time, and provide a reference for colleagues across the country, so that more patients with new coronary pneumonia can benefit.

The group text / our reporter Kuang Xiaoying co-ordinator / Jiang Shuo